Mont. Medicaid Hospice Policy Manual, Policy 601

ANNUAL UPDATES OF THE PAYMENT RATES

AND ADJUSTMENT FOR AREA WAGE

DIFFERENCES

APPLICABILITY

Medicaid hospice payments for each of the categories of hospice

care described in Hospice Policy 600, are calculated based on the

annual hospice rates established under Medicare. These rates are

authorized by section 1814(i)(1)(C)(ii) of the Social Security Act

which also provides for an annual increase in payment rates for

hospice care services.

ANNUAL UPDATE

OF THE PAYMENT

RATES

For fiscal year 2014 and subsequent fiscal years, in accordance

with section 1814(i)(5)(A)(i) of the Act, in the case of a Medicaid-certified hospice that submits hospice quality data, as specified by

the Secretary, the payment rates are equal to the rates for the

previous fiscal year increased by the applicable hospice payment

update percentage increase.

For fiscal year 2014 and subsequent fiscal years, in accordance

with section 1814(i)(5)(A)(i) of the Act, in the case of a Medicaid-certified hospice that does not submit hospice quality data, as

specified by the Secretary, the payment rates are equal to the rates

for the previous fiscal year increased by the applicable hospice

payment update percentage increase, minus 2 percentage points.

Any reduction of the percentage change will apply only to the fiscal

year involved and will not be taken into account in computing the

payment amounts for a subsequent fiscal year.

ADJUSTMENT FOR

WAGE

DIFFERENCES

Each hospice's labor market is determined based on definitions of

Metropolitan Statistical Areas (MSAs) issued by the Office of

Management and Budget. CMS will issue annually, in the Federal

Register, a hospice wage index based on the most current

available CMS hospital wage data, including changes to the

definition of MSAs. The payment rates established by CMS are

adjusted by the Department to reflect local differences in wages

according to the revised wage data.

FEDERAL REGISTER

NOTICES

CMS publishes as a notice in the Federal Register any proposal to

change the methodology for determining the payment rates.